Another insurance question

[doodle]

Exclusions this time. Robins renewal came through. I have claimed for hock arthritis and ulcers. (Also claiming for his lung infection and anaemia but guessing this has missed the cut off). So they have excluded entire gastrointestinal system. Also “conditions causing the clinical signs of lameness, both hind limbs”.

is the entire gastrointestinal system normally excluded for ulcers? We know about the gastric ulcers and then added sucralfate for hind gut as he wasn’t improving. So I kind of understand that. But does that mean if he comics at all he is not covered?

Also the hind limb lameness. We have xrays to show exactly which joint was causing the issues. So to exclude the whole back legs is a bit over the top? Does that mean if he cuts his leg he is not covered?

I will email them for clarification but am I on a hiding to nothing?

 

[milliepops]

i think it's not unheard of, I'm expecting similar after current ulcer claim. if you have a supportive vet they may write a letter to help you challenge it.

 

[doodle]

The lameness or the gastro exclusion?

 

[milliepops]

i'd try challenging them both if vet agrees nothing ventured, nothing gained!

 

[Lady Jane]

I would call them and go through your questions but the hind leg exclusion should not exclude injury where there is an external wound. Does it exclude soft tissue injury? Which joint is the problem. Have you read all the small print?

 

[HobleytheTB]

I claimed for a tendon injury, and lameness related to the hindlimb "below the hock" was excluded. Any kind of open wound is still included regardless of where it is!

I think it's fairly normal for them to exclude gastric issues after ulcers unfortunately. If he had something affecting the intestine, but not the stomach, it might be worth a go?

 

[Muddywellies]

Very much depends on the insurance company. When with KBIS, I claimed when horse got a large thorn in his coronary band. They promptly excluded that entire leg for everything! I got tired of KBIS being so trigger happy with exclusions (there were about three exclusions, not leaving much to insure) so with new horse I went with NFU. Their exclusions are far more specific and realistic. I too have claimed for ulcers but NFU haven't excluded the entire gastrointestinal system, just ulcers and conditions arising from ulcers.

 

[doodle]

I used to use nfu but the premium went up to £100 per month due to previous horses claims. Seib have said that if I don’t renew they will stop paying any claim and in that I have 3 ongoing atm and just started I would be in trouble. I do then wonder about going back to nfu. Seib were good with a previous exclusion for cellulitis and removed that after a year with no more issues.

 

[racebuddy]

Mine had full exclusion on when was treated for ulcers whole of the gastrointestinal system, the insurance said had to leave on for 2 years and will review to narrow down to ulcers only x

 

[doodle]

I can kind of understand the ulcers/gastrointestinal thing but the lameness is mad. We have xrays to prove where the issue is. If I remember right nfu excluded hock arthritis after Mintos diagnosis. It was only 6 years later when he got fetlock arthritis that they excluded any arthritis rather than specific legs.

 

[doodle]

Email sent asking for clarification and if it is possible to lift after a certain time.

 

[Fruitcake]

They tried the “entire gastrointestinal system” clause for me after an ulcer claim too. My vet wrote a strongly worded letter, pointing out they wouldn’t exclude, for example, the whole head after a claim for an issue with an eye and they backed down straight away. It was changed to “claims connected to gastric ulcers.”

 

[Fruitcake]

Also, excluding both hinds after a claim for any kind of lameness in one is, apparently, because compensatory issues can occur in the other as a result of the first. If you can prove he’s sound for a certain amount of time, they’ll usually lift the exclusion on the other leg.

 

[doodle]

Also, excluding both hinds after a claim for any kind of lameness in one is, apparently, because compensatory issues can occur in the other as a result of the first. If you can prove he’s sound for a certain amount of time, they’ll usually lift the exclusion on the other leg.

Arthritis found in both hocks.

 

[Fruitcake]

Arthritis found in both hocks.

Oh, that might not be as easy to have removed then. I imagine, they’ll claim any subsequent lameness could have arisen as a compensatory issue from the arthritis. ?

 

[doodle]

Yes possibly. I have asked specifically if cuts and broken legs included. A cut leg needing treatment they can’t possibly argue is related.

 

[SusieT]

Yes, whole GI system will be excluded which tbh - once a horse has had ulcers they are a much higher risk for colicng/problems so you can see their point.
I assume cuts won't be excluded but worth clarifying that. I'd try and get them to change it to relating to osteoarthritis in hind limbs or similar.

 

[Melody Grey]

My horse has his entire gastrointestinal tract excluded due to ulcers too. Also other exclusions for lameness work up and treatments, which doesn’t leave a lot left to insure! I’m sure I read on here someone in the same situation who had gone for ‘catastrophe (?) insurance’ which if I remember rightly did seem to cover colic - might be worth looking at if you’ve racked up exclusions in multiple areas?

 

[doodle]

Thought I would update this for anyone in same situation.
After an email from the vet to state the diagnosis. They have reduced the “lameness” to connected to “the hocks” and connected to “spavins”. Which I think it fair enough.

They have also said if after 2 years he has had no more issues with the gastrointestinal system and not on any medication, they would lift that exclusion and instead it will be ulcers only excluded which I cannot ever lift. Again I think this is fair enough.

The lungs/anaemia Havnt been included yet as they hadn’t had the claim for long enough so we will see at next renewal.

 

[criso]

ISeib have said that if I don’t renew they will stop paying any claim and in that I have 3 ongoing atm and just started I would be in trouble.

I would double check that. I chose not to renew my insurance halfway through a claim and they continued to pay out for the 12 months post start of claim. The claim ended 6 months after insurance wasn't renewed.

However when I started to get quotes most insurers said they would not take on a client with an active/ongoing claim so I took out catastrophe insurance which covers injuries and a few extras.

 

[doodle]

Unfortunately it was in writing. Second last paragraph.

 

[criso]

Makes me realise I was lucky then, this was with Towergate.

I didn't renew because when I joined they slapped loads of exclusions e.g. a whole leg for an overeach injury; the respiratory system because I had got Ventapulmin for my other horse and 'injury' to another leg where there had been a cut.
Got the unnecessary ones lifted after months of wrangling and a letter from a vet but was so fed up with them didn't want to renew.

Most of the expenses on the claim happened after I cancelled.

 

[milliepops]

KBIS continued to pay an existing claim after I let a policy lapse.
Bit of a bugger with SEIB ?

 

[cbmcts]

Hi OP

I think you may be able to challenge the requirement to renew for a current claim as an unfair T&C. Your policy probably says that all incidents that are accepted as a valid claim are covered for 12 months after starting. So if your policy renews in February and you have an ongoing claim from June, in theory they could set your premium at £1k per month in the new policy year to force you not to renew.

My experience is with financial services admin rather than insurance itself but the regulators are very hot on fair treatment of customers and it not as easy as it used to be for companies to play silly b*ggers to avoid paying out. It might be worth sending an email titled complaint Capital letters, in bold - insurers have a regulatory duty too handle to complaints in a formal manner and get into a lot of trouble if they don't!) to customer services asking why this requirement is in place when it is unfair due to the claims being within a policy year and already accepted as valid.

 

[Polos Mum]

I think the theory on lameness is that if he has known degenerative hock changes he could hold himself differently / move differently to accommodate and that is why he is at higher risk of having other issues.
It's the same as excluding both legs when the issue is only on one - they will put extra pressure on the 'good' leg putting it at more risk.

Worth arguing but be prepared not to get very far.

 

[doodle]

I think the theory on lameness is that if he has known degenerative hock changes he could hold himself differently / move differently to accommodate and that is why he is at higher risk of having other issues.
It's the same as excluding both legs when the issue is only on one - they will put extra pressure on the 'good' leg putting it at more risk.

Worth arguing but be prepared not to get very far.

yes I updated this a couple of posts up.

 

[doodle]

Hi OP

I think you may be able to challenge the requirement to renew for a current claim as an unfair T&C. Your policy probably says that all incidents that are accepted as a valid claim are covered for 12 months after starting. So if your policy renews in February and you have an ongoing claim from June, in theory they could set your premium at £1k per month in the new policy year to force you not to renew.

My experience is with financial services admin rather than insurance itself but the regulators are very hot on fair treatment of customers and it not as easy as it used to be for companies to play silly b*ggers to avoid paying out. It might be worth sending an email titled complaint Capital letters, in bold - insurers have a regulatory duty too handle to complaints in a formal manner and get into a lot of trouble if they don't!) to customer services asking why this requirement is in place when it is unfair due to the claims being within a policy year and already accepted as valid.

Thanks. Yes it does say the claim is valid for 12 months but then also states that if I don’t renew they will stop all claims.

I have had yet another hurdle from them this morning. Again one person saying one thing and the next person the opposite.

I replied to that and asked how I put in a formal complaint. And also said how they had basically blackmailed me re renewal. I have had enough of them not.

 

[criso]

However as I said, while my previous insurer did pay after I left, the only one prepared to take a client with an open claim was an E and L policy. That's why I ended up with catastrophe cover only.

 

[Fruitcake]

I might be wrong, but I don’t read this paragraph as saying you have to renew - just that you can’t cancel. The way I see it, they’re two different things.

 

[doodle]

I might be wrong, but I don’t read this paragraph as saying you have to renew - just that you can’t cancel. The way I see it, they’re two different things.

Ah ok, yes fair point I didn’t read it that way.